Background Schizophrenia guidelines have been developed throughout the world. However, guidelines differ considerably in methodology and content. Aims To systematically compare national schizophrenia guidelines from different countries. Method An international survey was conducted on guideline development and a methodological comparison was carried out by means of a validated guideline appraisal instrument (AGREE). Results The methodological quality of many schizophrenia guidelines was at best moderate. Few guidelines included key stakeholders. Whereas pharmacotherapy recommendations were quite similar, there were strong variations in the type of psychosocial interventions recommended. Conclusion Guidelines’ methodological quality has a strong influence on its applicability. However, the lack of financial means to develop and implement guidelines is perceived as a main problem. Independent international organisations may contribute to define a core set of non-biased schizophrenia treatment recommendations. In countries with a shortage of resources, this could be a basis for adaptation to different cultural and economic backgrounds in collaboration with stakeholders. Declaration of interest This work was financed by the German Society of Psychiatry, Psychotherapy and Nervous Diseases DGPPN and the German Research Network on Schizophrenia within a guideline programme (S.W.). W.G. is one of the editors of the German schizophrenia guideline from 1998; J.M. is the Chairman of the US Steering Committee on Practice Guidelines.